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127 Conifer Court Lot 11DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001597 Tax PIN/EH #: 5861-58-2442 Billed To: Marquis Building Subdivision Info: Redland Lot # 11 Reference Name: Location/Address: 127 Conifer Court -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3285 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT CONSTRUCTION IS VALID O A PERIOD OF FIVE YEARS. � p Environmental Health Specialist's Signature: Date: CERTIFICATE OF N **NOTE** The issuance of this Certificate of Completion shall indicate the stem (scribed on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 1 OA, S tion .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee th the s tem will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) .r ,,Vj Ou,,�7 ,4 j Z tte� Date: ,?'� Y 45 v1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 • (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Billed To: Marquis Building Reference Name: Proposed Facility: Residence Tax PIN/EH M 5861-58-2442 Subdivision Info: Redland Lot # 11 Location/Address: 127 Conifer Court -27006 Property Size: see map ATC Number: 3285 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms #Baths ,212_ Dishwasher: 2TOO' Garbage Disposal: ❑ Washing Machine: E ! Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply ��_ Design Wastewater Flow (GPD) C !/ Site: New RIO' Repair ❑ .e i System Specifications: Tank Size/ 4W GAL. Pump Tank GAL. Trench Width Rock Depth /,2 Linear Ft.-faa Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISERS) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) '09/25/2002 12:44 9406947 GORDON WHITNEY PAGE 01 • APPLICATION FOR SITE EVAILI ATION/I6IPRO OM M PERMIT t ATC O Davie County Health Depattinent Env/mpn►BrrGt///M/dI SeCIAM Y.O. Bos: 649/210 Hospital Street O Nooksville, Nc 27026 (336) 751-6760 rrrl��•err THIS APPLICATION e�Dr BS PRO===) UKISIS ALL TEN RZVT=BD INFORMhTION I6 PROVIDZD. 1tafar to the INVOIODITION BULLLTIN for instructions. R� 200 1. sane to be Billed ftl & a l s L01 0 uJy Ty— contact p rem rt tTyE'?�gPIZ' q1/ nailing Address P.Q. 1,.- 2A7y _ lane Phone 5'4�-„['G 41 city/state/LIP llucx , N G nmc- Business Pane _ 314 5'_ 311 v 2. sass on resit/h2C if Different than Above Nailing Adpress City/state/sip 3. Application For: 0 Site Lvaluation • Improvement Permit/ATC 0 Both A. system to aft—L : • House 0 Ndbile Homo Ll Business 0 Industry 0 Other 5. If Residence: s People s Bedrooms 3 a Bathrooms 40 Dishwasher n Garbage Disposal S Mashing Machine n aasssest/Pluabing 1 mase r t/wo P1nsUing 6. Ii Business/Zndnstsy/Ot11er: specify type s people 6 links s Ca --odes ! showers a Urinals s Dater coolse IF TOODSERVICL: # Seats Lrstimated Nater Usage (gallons par day) 7. Type of water supply: a County/City O wx11 0 community a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes *No If yes, what type? •'•IMPORTANT"* CUEN73 MUSTCOMMZMTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SI'Z'E PIAN MUST RESI/BM/77ED by the curet wlth THIS APPLICATION. Prop" Dimensions. 23 6 E iv? y, Z tp x /ir d x n WRITE DIRECTIONS (from Mac/hs�vllk) to PROPERTY: Tax Omct PIN: >M Bio 15 8 41 //S`� 6}4•S7' /-. /ffD I&.k,. Property Address: Rand Name 2 (� �t! q lL!/► Si e wJ / �Q/ .-- City/Zip & Aa%Lj� I -k V If in a Subdivisionprovideiaforntatioa, as follows: Name::° Section: Block: Lot: Date Property Flagged: 2 to 2 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or cbsoged. /, also, rndentand that I ant rexponsible for all charges Incurred frau this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located is Davie Cemty cad to conduct all testing procedures as necessary to determine the site suitab DATE 1 lS 'V SIGNATURE THIS AREA MAY B USED FOR DRAWING YOUR SITE PLAN (Iwcl de all of tie following. Existing 4d proposed property lines and diatessioss, structures, setbacl% and septic locntkms} Site Revisit Charge Date(* Client Notification Date: EHS: Account No. Gp Revised DCHD (07/99) Invoke No. a e El sl�� �-1✓�M C�P t3��s� 09/25/2002 12:44 9406947 GORDON WHITNEY MviS '13o,LD,,J6.- PAGE 02 r QO, APPLICATION FOR SITE EVALUATION/ IMPROVEMENT PERMIT & ATC • Davie County Health Department Environmental Healtir Section (� P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 JUN t 4 * * * XWCRTANT* * * THIS APPLICATION CANNOT BIC PROCESSED UNLESS ALL Tto RE ED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i struotfklix'8WFN LOUNIY l. Name to be Filled 4'42J--1q)b'.d / Contaot Person Nailing Addres. 3 �4 ¢ Bone Phone city/state/SIP 1111 c., Ae. Business Rho" 2. Name on Permit/ATC if Different than Above Nailing Address City/state/Eip 3. Application For: U Site Evaluation 0 Improvement Permit/ATC ❑ Both *. System to service: O�House ❑ Mobile Home 0 Business 0 Industry ❑ Other w.�.,.«. 5. If Residence: + People 1 Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Naahine ❑ Basemant/Plumbing ❑ Basamant/No Plumbing 6. If Business/Industry/Other: Speoify type i People f Sinks # Commodes # Showers M Urinals t} Mater Coolers IF FOODSERVICE: # Seats Estimated Yater Usage (gallons per day) 7. Type of water supply: 9-County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system b Intended to serve? 0 Yea 0 No If yes, what type? I***IMPORTANT"** CLIENTS MUST COMPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 6 5 )Ie ro5 -7L Tax Office PIN: # "51?z 1 — 5 C — S 3-- PropertyAddress: Road Name AVC/ jS 5�j City/Zip _ Aei✓ 111' e& , )'1 _L° , 91-Ttt If In a Subdivision provide Information, as follows: Name: P �:� �� "A- Section: ASection: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Prf0to)4 PILI -1V4- fz! i- D-7-/,9/ 4- IXof Date Property Flagged: This Is to certify that the Information provided Is correct to the best of my knowledge. I understand that any permit(,) Issued hereafter are subject to suspension or revocation, If the site plans or Intended use change, or if the information submitted In this application Is fabilied or changed. I, also, understand that I am responsible for all charges Incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE �, — 1/(9/ SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includd all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 0 Site Revisit Charge Date(s): I Client Notification Date: I EHS: Account No. ' 7 C Revised DCHD (07/99) Invoice No. 2:: -)— .r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.11 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 11 Reference Name: Location/Address: LISHighway 158-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: :V/O O Water Supply: On -Site Well Community Public / Evaluation By: Auger Boring Pit / Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH - ) Texture group C4 - Consistence SS, Structure S Mineralogy: ) HORIZON II DEPTH 10.2 ' 3 Texture group Consistence 1~'S Structure Rjlr Mineralogyl' HORIZON III DEPTH LN -32-,-s-0 Texture group 'r Consistence ' S Structure k Mineralogy1 HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: /� J EVALUATION BY: C t - ' wC24 ' OTHER(S) PRESENT: LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised)